Philosophy of Science Association Functionalism and Reductionism Author ( s ) :

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The authors aimed to describe pediatric mortality trends by CHD lesion in the United States. They found that CHD mortality is decreasing for most lesions. Because of the heterogenicity of CHD lesions, there is expected variability in mortality trends by lesion and age group. Single ventricle lesions continue to contribute most heavily to premature death because of CHD demonstrated by significant increases in mortality rate for children aged 5 to 17 years.
Active treatment of infants born at 22-25 weeks of gestation in California, 2011-2018 In California, active treatment rates at 23 weeks of gestation increased between 2011 and 2018, but rates at 22 weeks did not. At 22 and 23 weeks, rates increased during the latter part of the week. Several maternal and infant factors were associated with the likelihood of active treatment. Factors associated with increased odds of active treatment included maternal Hispanic ethnicity and Black race, preterm premature rupture of membranes, obstetrical bleeding, antenatal steroids, and cesarean delivery. Factors associated with decreased odds included lower gestational age and small for gestational age birth weight. Early brain and abdominal oxygenation in extremely low birth weight infants Valerie Y Chock, Emily Smith, Sylvia Tan, et al. Pediatr Res.
The authors describe a prospective study evaluating changes in cerebral and mesenteric saturation (Csat; Msat) over the first week after birth in ELBW preterm infants using NIRS. The study showed that both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction (n=124). Oxygen extraction (FTOE) increased more in the brain compared to the gut in infants with lower gestational age and birth weight, and 5-min Apgar score ≤5. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001). The authors concluded that brain oxygen extraction preferentially increased in more immature and anemic preterm infants.
Oral versus intravenous paracetamol for patent ductus arteriosus closure in preterm infants Ayala Gover, Philip T Levy, Avi Rotschild, et al. Pediatr Res.
This retrospective study compared oral or intravenous paracetamol as the first-line treatment for PDA constriction in preterm infants <37 weeks. Of 80 preterm infants who received paracetamol, 50 received it as first-line treatment for PDA constriction. Oral group had higher closure rate (15/19, 79%) versus intravenous group (8/20, 40%; p<0.01) retaining significance after adjusting for gestational age, length of treatment, and postnatal age (OR 0.14, 95% CI 0.03-0.67, p = 0.014, RR 0.51, 95% CI 0.28-0.91). Combined oral and intravenous paracetamol had a closure rate of 45% (5/11). The study concluded that oral paracetamol as first-line agent is more effective for PDA constriction than intravenous paracetamol. SIDS is associated with prenatal drug use: a meta-analysis and systematic review of 4,238,685 infants Louise Makarious, Arthur Teng and Ju Lee Oei. Arch Dis Child Fetal Neonatal Ed.
This systematic review included cohort, population or case studies comparing the incidence of SIDS among drug-exposed with drug-free controls (36,730 infants with any prenatal drug exposure, 21,661 exposed to opioids, 21,571 exposed to cocaine, 5,031 exposed to methadone compared with 4,201,955 with no exposure). Any prenatal drug exposure was associated with an increased crude risk of SIDS (RR 7.84, 95% CI 5.21 to 11.81). Prenatal opioid exposure had the highest associative crude risk of SIDS (RR 9.76, 95% CI 5.28 to 18.05), followed by methadone (RR 9.52, 95% CI 4.60 to 19.70) and cocaine (RR 4.40, 95% CI 2.52 to 7.67). Increased crude risk persisted after adjusting for socioeconomic factors (RR 4.24, 95% CI 1.39 to 12.88).
Effect of enteral long-chain polyunsaturated fatty acids on retinopathy of prematurity: a systematic review and meta-analysis Shivashankar Diggikar, Abhishek Somasekhara Aradhya, Ravi Shankar Swamy, et al. Neonatology.
This meta-analysis included 9 RCTs of 2,482 infants. Of the nine RCTs, six studies provided LCPUFA as a separate intervention in different concentrations, and three studies provided formula milk enriched with LCPUFA. In addition, five studies recruited infants below 32 weeks of gestational age. Supplementation of LCPUFA did not reduce the incidence of severe ROP with very low CoE (RR 0.71, 95% CI: 0.50-1.01, 5 studies, 1,822 infants), any ROP with very low CoE (RR 0.95, 95% CI: 0.73-1.12, 6 studies, 1,177 infants), or ROP requiring treatment with very low CoE (RR 0.92, 95% CI: 0.62-1.38, 4 studies, 1,395 infants). This meta-analysis of six randomized controlled trials with 357 participants compares surfactant delivery via laryngeal mask airway compared with control (continuous positive airway pressure or surfactant via endotracheal tube). Birth weight, gestational age, mode of delivery and prespecified criterion for surfactant administration were comparable between LMA and control group for each study. Surfactant administration via LMA significantly reduced the FiO2 requirement from the baseline (mean difference = 10.55, 95% CI: 5.66-15.44, n = 105, p < 0.001). LMA was associated with significant reduction in need for MV compared with the control group (RR = 0.49, 95% CI: 0.38-0.63, p < 0.001, number needed to treat [NNT] = 4; the need for intubation (RR = 0.28, 95% CI: 0.14-0.58, p = 0.0006, NNT = 1.8). The need of repeat dose of surfactant in LMA group was comparable to surfactant via ETT group. There were no significant differences between control and intervention groups in terms of death, BPD, and pneumothorax. This study has several limitations largely due to small sample size and heterogeneity, but it suggests that LMA might be useful used as an effective means of delivery of surfactant for neonates with RDS, particularly in resource limited setting. This study analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight <1,500 g were included. A total of 818,945 neonates were included in the study. Mortality within the cohort was at 16.2%. A total of 17.5% of neonates in the study were diagnosed with ROP. Both ROP and severe ROP trends increased significantly over the years (p < 0.001). In 2002, a total of 958 neonates were diagnosed with ROP, whereas 10,725 neonates were diagnosed with ROP in 2017. Severe ROP (stages 3, 4, and 5) has increased from 0.5 (2008) to 3.6% (2017). A total of 57 infants were diagnosed with blindness during the 16-year study period. There was no trend for increased or decreased blindness over the years. Prevalence of both ROP and severe ROP increased significantly over the study period. LOS also had increased, while the prevalence of NEC did not change. Increased ROP and severe ROP were consistent in the three GA and BW subgroups.